Chamber and committees

The bill proposes a 200m radius, but there will be places that will require a wider, or perhaps a different, area. Do you have any thoughts about the 200m limit?

Therefore, the future-proofing aspects of the bill’s provisions need to ensure that there is the flexibility to allow for GP practices, pharmacies or other locations to be included, based on application and ministerial approval. Is anything missing from the bill with regard to expanding or even reducing the premises that are covered?

I welcome the opportunity to lead this debate on eating disorders awareness week 2024, which took place from 26 February to 3 March. The theme of this year’s week is avoidant/restrictive food intake disorder, which is also known as ARFID. It is a largely unknown and misunderstood eating disorder, which can have serious consequences for health if it is left untreated.

The number of people who are affected by ARFID is unknown and treatment is not currently available nationwide. Many people with ARFID report difficulty in accessing treatment and support in Scotland and across the United Kingdom—I will come back to that.

I thank colleagues on all sides of the chamber who have supported my motion, which has allowed the debate to go ahead. I also thank the eating disorders charity Beat for the excellent work that it continues to do to support those who are at risk of, or living with, an eating disorder. That work includes supporting family and friends.

Around 1.25 million people across the UK and about one in 50 people in Scotland currently live with an eating disorder, and the numbers increased during the Covid-19 pandemic. Types of eating disorders include binge-eating disorder; bulimia; anorexia; other specified feeding or eating disorders, or OSFED; and avoidant/restrictive food intake disorder, which we are discussing today. Another, very dangerous, eating disorder is diabulimia, which occurs when people with type 1 diabetes deliberately omit their insulin in order to control their weight.

Eating disorders have high mortality rates, and anorexia has the highest mortality rate of any mental illness. One in six people with a binge-eating disorder has reported trying to end their life. People with eating disorders typically develop severe physical health problems, and it has been estimated that their overall quality of life is as low as it is for those with symptomatic coronary heart disease or severe depression. Without early intervention, many people become unable to participate in education or employment. However, recovery is possible. Access to the right treatment and support is life changing, and early intervention provides the best chance of recovery.

The key symptoms of eating disorders include worrying excessively about weight and body shape, avoiding social situations where food may be involved, frequently visiting the toilet for prolonged periods after meals, and a person not being up front about the food that they may be consuming. It is important for family members, friends and colleagues to be aware of those signs. Research has shown that there is a link between eating disorders and depression, low confidence and low self-esteem.

Today, however, I will highlight specifically this year’s theme: ARFID. ARFID is a condition that is characterised by the person avoiding certain foods or types of food, having restricted intake in terms of the overall amount eaten, or both. Beat has experienced an increase in requests for support for people who are living with ARFID. One of the people who have been impacted by ARFID, Harriet, summed up the impact of the condition by saying:

“A lot of people thought I was just being picky and friends would often get very offended when I went round to their houses for dinner and I wouldn’t eat anything. Less than five people outside my immediate family knew about my condition. When I explained it wasn’t to do with losing weight, it was because of anxiety, I was told to get over it.”

That example shows exactly why we need to put the spotlight on ARFID: so that people are aware of it, and so that we can break down the stigma and support people to access treatment.

People of any age can have ARFID. The condition is linked to anxiety, attention deficit hyperactivity disorder and autism. People with ARFID may be sensitive to the taste, texture, smell, appearance or even the temperature of the food in front of them.

In March 2021, the Scottish Government completed a national eating disorder service review. The “Scottish Eating Disorder Services Review—Full Report” includes a total of 15 ambitious recommendations that focus on ensuring that all those who are affected by eating disorders receive timely and appropriate care and support. Those recommendations include better co-ordination of national activity and data collection; national availability of self-help resources, which should be available to everyone in Scotland, at any stage of life; and a focus on early diagnosis, with the aim of prevention. It is welcome that an implementation group has been set up to review the timescales for, and the cost of, implementing the recommendations, and that three sub-groups have been created: a training group, a standards group and a data group. One of Beat’s key policy asks is for the 15 recommendations to be implemented in full. I would be grateful, therefore, if the Minister for Social Care, Mental Wellbeing and Sport could, in responding to the debate, provide an update on the implementation of those recommendations and comment on when they will be implemented in full.

Ahead of the debate, my office contacted NHS Dumfries and Galloway and spoke specifically with the dietetics team. The team has a specific dietician who works with and focuses on those people who are living with, or at risk of, developing eating disorders. I heard that because of the rural nature of Dumfries and Galloway, some people who are at risk of developing an eating disorder may not be picked up as easily, or may be reluctant to access support because of the travel that is involved in attending appointments. In addition, because of the stigma around eating disorders, many people report that they feel ashamed even to access treatment and support.

Although the situation has improved through a move to virtual appointments, people who live in rural areas still have issues in accessing eating disorder support services. We need to continue to support them to access those services, so I ask the minister to ensure that rural areas are included in the Government’s approach. In addition, I press the Scottish Government to ensure that eating disorders are included in the mental health stigma reduction strategy, and that all possible action is taken to combat eating disorder stigma.

Anyone who has an eating disorder, or who thinks that they may be at risk of one, can access judgment-free support from Beat. The helplines are free to call from all phones. Anyone who is affected by an eating disorder—including families, carers and anyone else who provides support to someone with an eating disorder—can call 0808 801 0432 or email [email protected], or contact Beat’s helpline advisers via a one-to-one webchat. The helplines are open from 3 to 8, seven days a week, 365 days a year.

I appreciate the opportunity, once again, to lead this important debate, and I reiterate my ask of the minister for further detail on when the review group’s recommendations will be implemented. Once again, I thank Beat and all the national health service staff across Scotland for the vitally important work that they do each day. I look forward to hearing the contributions from other members.

I remind members that I am still a nurse and that my experience was in the perioperative environment.

Will the cabinet secretary speak to the importance of ensuring that patients are involved in every step of the process, so that their voices and experiences are heard?

I will come on to self-directed support, but it is part of the complex landscape that needs to be reformed, so that we can make changes and help to support the most vulnerable people who need care.

It is clear from the evidence that one of the best ways to make the necessary changes is by reforming integration joint boards, as the minister set out to the committee. The committee has heard repeatedly from people with lived experience that the current adult social care system must change so that we can drive up standards to a consistent level across our country.

One of the ways in which it is intended that the aims of the bill be met is through the creation of a national care service board. The NCS board will ensure that consistent, fair and human rights-based social care support and community health services are in place. It will be responsible for reviewing and overseeing the performance of local strategic plans. To support that, the Scottish Government proposes to transfer ministerial powers of intervention to the board, which will be able to invoke them as a last resort. That will give the board the levers that it will need to drive and support performance, and—if required—to act.

As a former clinical educator and a nurse, I am interested in how the NCS board will help to standardise how we approach social care and social work and care across Scotland. Just this week, my office spoke to a local organisation that provides care across Dumfries and Galloway about the NCS board and standardisation, and it welcomed the approach.

Stewartry Care, which is one of the largest providers of social care in Dumfries and Galloway, gave evidence to the committee when we visited Dumfries. The other day, it told my office that, although it provides mandatory moving and handling training for its staff, much of the training that it provides on top of that is not mandatory. Stewartry Care also trains staff on how to assess nutritional status, and staff are educated on how to spot the signs and symptoms of malnutrition among those within their care.

However, as was evident from my meeting with the Food Train last week, the provision of such education is not universal practice. Many care providers do not offer such education or training, despite the importance of nutrition and the commitments in the Good Food Nation (Scotland) Act 2022 that was passed by this Parliament.

That is just one example of an area of education that would benefit from standardisation across Scotland. I ask whether the minister agrees with me and whether she will consider making nutritional monitoring one of the national standards as the bill progresses. I am not necessarily suggesting that it should be done in primary legislation; I am simply saying that we should consider it as we seek to make progress on standards.

I also want to touch on the commitment to establishing a national social work agency, which COSLA has agreed with. For the people who work in the social work profession and their leaders, the establishment of a national social work agency is a vital piece in the jigsaw of reform. As has been noted by Social Work Scotland, the current national arrangements for social work are messy and inefficient, with the Scottish Government, employers, the Scottish Social Services Council, Social Work Scotland, improvement bodies and many others all separately “leading” on aspects of social work’s development.

If we are to effect the changes in social work systems and practice that were outlined in the independent review of social care and the Promise, which the profession itself has called for, we need to create an enabling context. The national social work agency has real potential to address those challenges.

Dumfries and Galloway Council pays its social workers lower wages than any other Scottish social work department. That is why some of our social workers are leaving to go and work south of the border or in other parts of southern Scotland. That issue could be addressed by progressing a national agency.

Another example is that of self-directed support, which Gillian Mackay’s intervention was about. Different local authorities take a variety of approaches to the administration of SDS. While some perform really well, others perform less well. Therefore, I ask the minister to confirm that it is the Scottish Government’s intention for the national social work agency to deal with such discrepancies, to support the social work profession and to get it right for those who engage with social work.

It is clear that the bill is needed to improve the social care and social work landscape in Scotland. I will support the bill at stage 1, and I urge other members to do so.

To ask the First Minister what the Scottish Government’s response is to the latest reported figures highlighting the impact of livestock worrying in Scotland. (S6F-02874)

On Gillian Mackay’s point about Anne’s law, I note that the committee took evidence from people with lived experience, the Scottish Association for Mental Health and the Health and Social Care Alliance Scotland, and they all supported our getting on with the bill and taking it forward. Is that also Gillian Mackay’s reading of the evidence that we took from them?

I welcome the debate and thank Paul Sweeney for securing it. The great daffodil appeal is one of the most iconic and recognised fundraising drives of the year. People all over the country wear their yellow daffodil badges, as we do today, with a sense of pride that they are supporting Marie Curie to deliver its world-class palliative care services in our communities and its hospices. I thank all the nurses, staff and volunteers who are part of Marie Curie.

One area of interest in the 2024 appeal is end-of-life poverty and improving the financial package that is available for palliative care. Rhoda Grant has just laid out the specific heating and nutrition challenges that some people face at the end of their life, especially in rural areas.

As a registered nurse and a member of the Parliament’s Health, Social Care and Sport Committee, I have an interest in our social care sector and feel passionately about ensuring that we equip the sector and, indeed, our population for years to come. Across Scotland and internationally, people are ageing better and living longer lives. That is welcome, but it presents challenges, because with age comes a greater risk of health complications and a greater need for social care support and services.

The health committee has carried out several inquiries relating to social care in Scotland, and the conclusions have always had similar themes. One of the main themes is that, as a society, we must be smarter and better prepared to deal with our ageing population, as Marie Curie suggests in its briefing for the debate.

The evidence shows that there must be an onus on healthcare professionals to have realistic conversations with people about their retirement. Future care must best support people staying at home, if that is their choice, and it is absolutely paramount that the care is suited to their needs. That is why the National Care Service (Scotland) Bill is so important.

Marie Curie is at the forefront of pioneering research in Scotland. Indeed, one of its most recent publications, which was produced jointly with the University of Edinburgh, suggests that, by 2040, two thirds of Scots—66 per cent of the population—will die at home, in a care home or in a hospice. Allowing more people to have the opportunity to die in a place that they choose is essential if we are to meet future care needs and reduce the demands on our acute services.

However, as Marie Curie points out, to achieve that, palliative care must have a fair funding settlement. One of the ways that Marie Curie suggests that can be achieved is through the Scottish Government working to a minimum target of 50 per cent statutory funding for independent hospice care providers, including those that provide hospice care at home. Given that, across Dumfries and Galloway, 4,359 visits were made to 542 people and patients by the region’s 31 dedicated Marie Curie nurses, I would welcome the minister’s comments on that ask by Marie Curie. Support from those dedicated nurses allowed 72.5 per cent of those with palliative and end-of-life care needs to die in a place of their choosing. However, again, funding is crucial to enable that support to grow to meet future demand.

It is welcome that, across South Scotland, Marie Curie has seven shops that are raising funds and more than 896 dedicated volunteers. There are shops in Stranraer, Newton Stewart and Dumfries, and there is a supporters group in Lockerbie. I will visit the Dumfries shop with Marie Curie leadership a week on Monday, and I look forward to continuing to support its work.

I again welcome the debate, and I congratulate and thank Marie Curie for the fantastic work that it does day in, day out to support those who require end-of-life and palliative care and their friends and family.

As a member of the Health, Social Care and Sport Committee who has been present during the entirety of the committee’s scrutiny of the bill and preparation of our stage 1 report, I welcome the fact that we are debating the bill at stage 1 today. I thank everyone who has been involved in providing evidence, the clerks and, of course, anyone who provides care for our people across Scotland.

We must remember that the bill is about a change that might be described as monumental, just as the creation of the national health service was. That was done through framework legislation, just like this bill.

The evidence that we have taken at committee has clearly demonstrated that the current social care landscape is cluttered and complex and that, fundamentally, it isnae working for those requiring care, who are some of the most vulnerable people in our society. The Parliament has a duty to those individuals to get the bill right and to create a social care system that meets the demands of our society and that is underpinned by the principles of human rights, respect and person-centred choices.

There is a need for standardisation of the social care system, employment practices, education for social care workers and social care standards across all of Scotland.

The Dogs (Protection of Livestock) (Amendment) (Scotland) Act 2021 has proved successful in raising awareness of livestock attacks and livestock worrying and in encouraging farmers to have the confidence to report livestock worrying incidents. However, NFU Mutual’s latest report on rural crime shows that livestock worrying reports are increasing. Stakeholders including NFU Scotland and Scottish Land & Estates have called for a change to the outdoor access code to mandate that dogs be kept on leads when in fields where livestock is present. Will the First Minister comment on how the Government can continue to raise awareness of my livestock worrying act and on whether it will consider making such an amendment to the Scottish outdoor access code as part of the upcoming land reform bill?